Child Abuse

Alternate Names
physical abuse
neglect
sexual abuse
emotional abuse

Definition of Child Abuse

The Child Abuse Prevention and Treatment Act of 1973 was enacted to protect children. It defines child abuse and neglect as "the physical treatment and mental injuring, sexual abuse, negligent treatment, or maltreatment of a child under the age of 18 by a person who is responsible for the child's welfare under circumstances which indicate that the child's health and welfare is harmed or threatened thereby." A non-accidental injury to a child may be physical abuse. Failure to provide a child with basic emotional and physical needs may be considered child neglect. Neglect includes not providing a child with basic medical care. Sexual abuse is defined as any sexual activity between an adult and a child.

What are the signs and symptoms of the injury?

Children who have been abused often have a variety of psychological problems and symptoms. Because many symptoms of abuse are also symptoms of other disorders or problems, no single symptom will necessarily indicate that abuse has occurred. For this reason, it is extremely important to have the child evaluated by an experienced healthcare professional.

Emotional and behavioral symptoms of child abuse may include:

• acting out sexually
• aggressive or violent behavior
• anxiety
• delay in developmental milestones
• depression
• feelings of guilt and shame
• frequent mood swings
• low self-esteem
• paranoid thoughts
• problems in relating to peers
• school and academic problems
• self-destructive or suicidal behaviors
• sleep problems and nightmares
• social withdrawal

The following physical symptoms may result from child abuse:

• bleeding into the retina or the conjunctiva of the eye
• blood in the urine
• bone fractures
• burns
• failure to achieve expected or normal weight and height growth
• frequent urinary tract infections
• multiple bruises, often at various stages of healing
• rectal or vaginal irritation or discharge
• sudden and severe abdominal pain
• unexplained cuts, swelling, and bruises

What are the causes and risks of the injury?

Children of all ages, ethnic and cultural groups, and socioeconomic levels are at risk for abuse. Certain factors put some children at higher risk for being abused. Three particular areas of stress have been shown to increase the risk of abuse to a child.

Child-produced stress factorsThese stress factors include a child who may be:

• an adopted child or foster child
• behaviorally different, such as children with attention deficit disorder
• mentally different, such as children with mental retardation or learning disabilities
• physically different, such as children with physical disabilities
• substantially different from other family members in temperament
• temperamentally difficult

Social-situational stress factorsThese stress factors include:

• parental relationship with dominant-submissive patterns
• physical or social isolation
• poor housing or frequent moves
• poverty or unemployment
• punishing child-rearing style
• significant change in family finances
• strained parent-child relationship, including unwanted children
• violent parental relationship

Parent-produced stress factorsThese stress factors include parents who have the following characteristics:

• depression
• history of abuse as a child
• lack of education about basic child-rearing
• low self-esteem
• psychiatric illness or character disorder
• substance abuse
• unrealistic expectations of their children

What can be done to prevent the injury?

It is important to make the community aware of the risks of abuse as well as the resources available for victims and their families. Developing trust within communities helps people talk about abuse.

Concerned friends, family or clergy need to ask directly about signs that may indicate abuse. For instance, if a neighbor child has unexplained bruising, ask that child how the injury occurred.

Even though a child may not describe to you exactly what happened, his or her reaction can still give you more information about the situation. Simply asking the right questions can sometimes reduce the risk factor of social isolation. Showing concern can give the child confidence that there is someone to turn to.

How is the injury recognized?

Child abuse is typically recognized in several ways. Often, a professional will be the first to recognize and report suspected abuse. This may be a teacher, day care worker, or healthcare professional. In other instances, a family member or neighbor suspects abuse.

Once abuse is suspected, the child should be evaluated by a healthcare professional. The evaluation will vary depending upon the type of abuse suspected. Unless sexual abuse is suspected, a gynecologic or rectal exam is not routinely performed. Unless the abuse is recent and rather severe, sexual abuse typically does not leave any physical marks.

If physical abuse is suspected, the healthcare professional will do a complete physical exam. For any injury or condition associated with child abuse, the professional should thoroughly question the caretaker. Sometimes abuse is diagnosed indirectly. During an examination, evidence of old injuries may become apparent.

What are the treatments for the injury?

A child suspected of having been abused should be evaluated immediately. The treatment will be dependent upon the injury or condition. Long-term emotional, psychological, relational and spiritual problems can stem from being a victim of child abuse.

Children who have been abused may benefit from counseling with a therapist and/or a pastoral professional. The counselor will help them work through feelings of low self-esteem, anger, and helplessness and can help the children learn and use new tools to protect themselves.

The parents or caretakers of the child should also receive counseling.

Parenting skills, alternative discipline methods, and anger management techniques can be learned. Unfortunately, there are times when a caretaker is not able to adequately care for the child. In these instances, the child typically has to be removed from the home to protect him or her from further abuse.

What are the side effects of the treatments?

In general, there are no side effects from treatment of child abuse. If medications are used to treat physical or mental conditions, they may have side effects.

What happens after treatment for the injury?

Child abuse can cause long-term psychological and physical problems for the child. Long-term counseling may be needed to help the child work through feelings and develop a healthy self-concept.